MEDICARE: DR. AURORA A ATIENZA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036057948	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750441465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AURORA A ATIENZA M.D.

Provider Business Mailing Address
First Line	:	3900 W MADISON ST STE 13
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-2354
Country	:	US
Telephone Number	:	773-533-3440
Fax Number	:	773-722-1200

Provider Business Practice Location Address
First Line	:	3900 W MADISON ST
Second Line	:	SUITE 13
City	:	CHICAGO
State	:	IL
Zip	:	60624-2354
Country	:	US
Telephone Number	:	773-533-3440
Fax Number	:	773-722-1200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	11/12/2014

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